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General NPI Number Information
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NPI Number | 1821355298
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Entity Type | Organization
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Legal Business Name | JOHNSON DENTAL CORPORATION
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 200 N LA CUMBRE RD STE H
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City | SANTA BARBARA
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State | CA
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Zip | 93110-1577
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Country | US
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Telephone | 805-960-5600
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Fax | 805-682-8899
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Provider Business Mailing Address
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Address Line | 200 N LA CUMBRE RD STE H
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City | SANTA BARBARA
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State | CA
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Zip | 93110-1577
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Country | US
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Telephone | 805-960-5600
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Fax | 805-682-8899
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MS. MARY JULIA MADDEN
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Credential | RDA
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Telephone | 805-682-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 53046
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 60946
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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